Health Insurance Marketplace FAQ

No doubt you’ve been starting to hear about the new Health Insurance Marketplace, a key part of the health care law, the Affordable Care Act (ACA). The ACA will expand coverage to millions of uninsured people through health insurance marketplaces that are now open. But you probably still have questions. Like what is the Marketplace, and can you and your patients really get health insurance? Your patients will have questions too. And we’ve got answers for you and your patients.

What is the Marketplace and where do I find it?

Starting this fall, Health Insurance Marketplaces will help eligible patients buy new health insurance plans that fit their needs and their budgets. The Marketplace is kind of a one-stop shop for consumers to research, compare, and buy different plans. The marketplaces are not private insurance companies or government-run health plans. The Marketplace will be open from October 1, 2013 through March 31, 2014. If you sign up by December 15, 2013 you will have coverage starting January 1, 2014.

What benefits are offered in the Marketplace plans?

All plans offered in the Marketplace must cover doctor visits, hospitalizations, maternity care, emergency room visits, prescriptions and more. Preventive services are FREE of charge and no one can be denied coverage because they are sick or have a pre-existing conditions like asthma, diabetes, or even cancer.

But I’m a Pre-Medical/Medical Student… do I need insurance?

YES! If you are under the age of 26 you can still have insurance through your parents (even if you don’t live with them). If you are over the age of 26 and need insurance you may qualify for a subsidy (if you make between 100- 400% of the federal poverty line).

If I have health insurance do I need to do anything?

If you have insurance through your employer you can choose to keep it or you can shop for a different plan in your state Marketplace. Though, remember if your employer is paying part of health insurance premiums and you decide to cancel your employer-based insurance your employer is not required to help pay your premiums. Under the Affordable Care Act, student health plans are not considered employer coverage, and if that is the only coverage you’re offered, you could buy a policy on a state exchange and you might qualify for subsidized coverage (See above subsidy calculator).

What if I don’t sign up for insurance?

If you don’t have health insurance and you chose not to sign up through the Marketplace, not only will you be responsible for all your medical costs, but starting 2014 you will have to pay a fee for not having health insurance.

I heard there are differences if my state is not expanding Medicaid… what is that about?

The ACA provides states the choice and additional federal funding to expand their Medicaid programs to cover people who make up to 133% of the federal poverty level. That’s about $15,800 a year for 1 person, or about $32,500 for a family of 4. (These are 2013 figures, and likely to be slightly higher in 2014.) Some states are expanding their Medicaid programs in 2014. Other states are choosing not to. This leaves some people with fewer options for coverage.

Even if your state is not expanding Medicaid, you should apply for coverage to see if you qualify. Your medical needs or unique circumstances might mean you qualify. You can apply today by contacting your state Medicaid office. Find contact information for your state Medicaid office by using the dropdown menu near the bottom of this page.

How should I talk with my patients about this?

AMSA has put together a white coat card to help you get the necessary facts at your fingertips.

Check out Doctors for America Webinar on October 1st, EVERY hour on the hour (from 9am to 5pm EST, and 9pm EST) for a 15 minute info and Q&A session on the new insurance options. Register online.

For more information:

The best place for the latest, most accurate, information on the Marketplace is the updated website, HealthCare.gov. At the site, you can learn what it is, who can apply for insurance, how to get insurance, how to lower your costs, and more. You can participate in an online web chat on the website; or call a toll free number, 800-318-2596, to speak with a trained customer service representative; and there will be people in your local communities who can give you personal help with your choices.